LeadingAge Magazine · November-December 2018 • Volume 08 • Number 06

Recruiting Foreign Nurses to Remedy Chronic Shortages

November 18, 2018 | by Jane Sherwin

One LeadingAge member has become experienced in recruiting nurses from the Philippines. Here’s a look at its successful program.

The data are clear: New sources are needed to provide adequate nursing and direct care staff for America’s older adults. Between the growing boomer population and the decrease in the hiring pool, what is to be done? One solution is hiring personnel from other countries.

What the Data Show

Based on current population and service utilization trends, 3.4 million direct-care workers will be needed by 2030, a 1.1 million increase over the current number who filled these jobs in 2015. The demand for registered nurses will grow by 46% and for LPNs by 46% between 2015 and 2030, according to Natasha Bryant, senior research associate at the LeadingAge LTSS Center at UMass Boston.

“Recruiting foreign workers really can help fill these staffing gaps,” says Bryant. “And overseas staffing brings diversity to the workforce, which helps with our multicultural consumer population.” The result is an opportunity for developing positive relationships between clients and staff.

Bryant says that many recruits come through informal networks, where personal connections help to build staffing. However, the recruiting experience of 2 LeadingAge members indicates the value of an organized approach, including use of a recruiting agency and legal advice.

Building an Overseas Pipeline

For almost 15 years, Chicago Methodist Senior Services (CMSS) has been hiring registered Filipino nurses to support their staffing needs. CMSS is an urban organization providing a full range of long-term services to some 600 clients per year.

CMSS photo
A group of CMSS nurses from the Philippines get their licenses on
a visit to Springfield, IL. Left to right: Janice DeBelen, Lea Capili
Czarina Mayono, Rosalea Redula and Laura Davidson, director of
recruiting and staffing for United Methodist Healthcare
Recruitment. Photo courtesy of CMSS.

“Our director of nursing was from the Philippines and she suggested starting the recruitment agency,” says Bill Lowe, president and CEO. “We are a longstanding organization and wanted to be sure we’d continue to have the nurses we need. Forty of our own nursing staff today (98% of the total licensed nurses) are from the Philippines.”

Based on the success of recruiting for their own staff, CMSS worked with its parent organization, United Methodist Homes & Services, to establish its own recruitment agency, United Methodist Healthcare Recruitment (UMHR), which provides overseas recruiting services for its own needs and for 6 other long-term care communities. That number is expected to grow.

Lowe says that, in addition to the other many advantages of an organized approach to overseas hiring, CMSS is saving a low 6 figures in recruitment and overtime costs. This is after related legal and certification fees.

Why the Philippines?

Lowe says the Philippines requires its registered nurses to complete a 4-year program, the equivalent of a Bachelor of Science in nursing. Their excellent training, coupled with a requirement to pass the test of English as a foreign language (TOEFL), results in their qualifying for licensure in the United States. Given the oversupply of nurses in the Philippines, they are a ready source for work overseas.

“Coming to the U.S. can be a life-changing moment for these nurses,” says Lowe. “For many of them, this is their first time in the U.S., and they are living out a dream. They are enjoying good, steady, consistent work, and increasingly they are gaining expertise in geriatric care, including memory care and Alzheimer’s.”

CMSS is not the only organization relying on Filipino nurses. Until the mid-1980s, according to a 2004 article in Health Affairs, these nurses represented 75% percent of all foreign nurses. By 2000 the figure had dropped to 43%, as nurses began to arrive from other countries.

The ABCs of Bringing Overseas Staff to the USA

  • Certify that a foreign worker is needed and post the job opening at your worksite.
  • Identify workers overseas who meet your requirements.
  • Petition USCIS for permission to bring the worker to this country, including a demonstration that your financial resources are adequate to cover their salary.
  • Obtain a visa from the US Embassy—this is the future employee’s task.
  • Once in country, support employees in obtaining license to practice in your state.
  • Invest resources in establishing a comfortable and welcoming situation for your new staff.

Getting Started

The first step in building nursing staff from overseas is to identify a useful recruiting source and begin the process of petitioning for nurse immigration to the U.S. All Filipino nurses must be processed by a Philippines-based agency.

Building a pipeline of candidates is an essential part of the process, according to both Lowe and Dilnaz Saleem, of counsel with Baker Donelson, specializing in employment-based immigration and based in Houston, TX. Saleem recommends that agencies project their hiring needs over the next several years, and consider filing even up to 30% more petitions for staff than they expect will be necessary. “People’s lives change,” she says, and visa requests may be rejected. In fact, there is a growing line of employees waiting for visas—it can be 1 to 5 years, for a number of individuals, before a visa is available. At the same time, says Saleem, “there is no question that nursing and direct care employees are going to have to come from overseas in order to meet increasing staffing needs.”

CMSS photo
In celebration of Nurses Week, a group outing in Chicago. Photo courtesy of CMSS.


Immigration Requirements and Challenges

While immigration laws have not changed substantially in the past few years, their interpretation has become more stringent, even before the 2016 election, according to Saleem. She thinks that restrictions are tighter on immigration for nationals of certain countries and for certain professions, and that the U.S. Citizenship and Immigration Services (USCIS, formerly the INS) tends not to consider LTSS staffing needs when reviewing visa petitions.

LeadingAge’s Bryant agrees that not a lot of visas are dedicated to LTSS. “It’s a difficult climate to lobby for these,” she says. “Other countries are creating permanent migration channels for aides and special visas for LTSS workers.”

“Given these pressures, we have to make these good jobs, so people want to stay in them,” says Saleem. “Some employees may see their LTSS job as an entry position, and plan to move on to other jobs. If they are sending money home, they may be pressured by families to move to higher paying hospital jobs. We need to pay attention to providing decent paying jobs.”

Getting Settled in Their New Country

Nurses from overseas who meet all requirements for entry into the U.S. will need welcoming and support during the months when they are in the country but not yet licensed.

“We are committed to them as long-term employees, and don’t treat them as a means to avoid another nursing shortage,” says Lowe. “In fact we’ve taken those words out of our language.

A Podcast on CMSS’ Recruitment of Nurses From the Philippines

Bill Lowe of Chicago Methodist Senior Services was interviewed earlier this year for a LeadingAge Workforce Innovators podcast, published by our Center for Workforce Solutions. He reviewed the reason CMSS launched its systematic program and explained its challenges and rewards.

“We provide them with at least 2 months of free housing and help them get a Social Security number. We also work with them to find permanent housing and furnishings, and introduce them to American culture,” says Lowe. He emphasized the importance of a warm welcome and making these new employees feel a part of their new world. “It’s not so much how long can we [keep you on] the job, as how can we support you, and an active and supportive social life is an important part of this.”

Bryant also emphasized the importance of “cultural competency training,” helping staff from overseas to understand the role of older adults in American culture and how dementia, death and dying are perceived.

Jay Biere, now CEO of Plymouth Place in LaGrange Park, IL, served until recently as CEO of Meadows Mennonite, in Chenoa, IL, a rural location with significant staffing challenges. Meadows Mennonite worked with UMHR to build its nursing staff.

“We had cottages on campus to house our new Filipino staff, and this worked really well,” says Biere. “They, and sometimes their families, became part of the Meadows Mennonite community, and we began to integrate them into our campus life. For example, we gave them 6 months of rent, even though only 3 months were required by UMHR.” Biere joined Plymouth Place only in January, but says his new organization is definitely planning on overseas hiring through UMHR.

“The demand for nurses is huge,” says Biere. “There won’t be enough without staff from overseas.”

Jane Sherwin is a writer who lives in Belmont, MA.